Stent/coil treatment of very large and giant unruptured ophthalmic and cavernous aneurysms

Surg Neurol. 2009 Jan;71(1):19-24; discussion 24. doi: 10.1016/j.surneu.2008.01.025. Epub 2008 Apr 18.


Background: Treatment of VLGUIA remains a challenge. To reduce mass effect and achieve complete occlusion, open surgery has been our favored treatment. However, endovascular therapy is preferred for lesions in the cavernous sinus or for older patients with complicating medical problems. The goal of this study is to investigate outcome of stent and/or coil treatment of VLGUIA.

Methods: Beginning in 2002, the neuroform stent has been available to the University of Texas Southwestern Medical Center in Dallas. Since then until 2006, 15 patients were treated for VLGUIA with stenting and/or coiling at this institution. These 15 patients were used for a retrospective analysis in this study.

Results: Median patient age was 65 years, median aneurysm size was 27 mm (20-37 mm), and median follow-up time was 22 months. Eight aneurysms were localized in the cavernous sinus and 7 at the ophthalmic segment of the internal carotid artery. Four aneurysms were completely occluded (100%); 3 aneurysms, nearly complete (90%-99%); and 8 aneurysms, partial (<90% occlusion). Twelve patients required retreatment. Final GOS was 1 (good recovery) in 11 patients, 2 (moderate disability) in 3 patients, and 3 (severely disabled) in 1 patient. No patient died or deteriorated.

Conclusions: Stent/coil management of VLGUIA is constantly evolving. Current treatment results are promising, with very low morbidity/mortality. Disadvantage is the frequent persistence of residual aneurysm.

MeSH terms

  • Adult
  • Aged
  • Cavernous Sinus / pathology
  • Cavernous Sinus / surgery*
  • Cerebral Angiography
  • Child
  • Eye / pathology
  • Female
  • Follow-Up Studies
  • Glasgow Outcome Scale
  • Humans
  • Intracranial Aneurysm / pathology
  • Intracranial Aneurysm / surgery*
  • Male
  • Neurosurgical Procedures / adverse effects
  • Neurosurgical Procedures / methods*
  • Ophthalmologic Surgical Procedures / adverse effects
  • Ophthalmologic Surgical Procedures / methods*
  • Retrospective Studies
  • Stents*
  • Treatment Outcome